Turk Kardiyol Dern Ars 2018;46(3):169-174 doi: 10.5543/tkda.2017.

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ORIGINAL ARTICLE

Assessment of healthy lifestyle behaviors after

coronary artery bypass surgery
Koroner arter baypas ameliyatı sonrası sağlıklı yaşam biçimi
davranışlarının değerlendirilmesi

Semiha Alkan, Esengül Topal, Muhammet Onur Hanedan, İlker Mataracı

Department of Cardiovascular Surgery, Health Sciences University Ahi Evren Thorax and Cardivascular Surgery
Training and Research Hospital, Trabzon, Turkey

ABSTRACT ÖZET

Objective: After coronary artery bypass graft (CABG) sur-
gery, there is a disease management process that patients
should follow, and healthy behaviors play a key role in this
process. The aim of this study was to evaluate the health-
promoting behaviors of patients after CABG surgery and to
determine the influential factors.
Methods: This was a cross-sectional study of 152 patients
who were admitted to the polyclinic between March and June
2016 and underwent a CABG procedure. The data were col-
lected using a patient information form and the Health-Pro-
moting Lifestyle Profile (HPLP). Number, percentage, SD,
mean, independent t and analysis of variance tests were used
to evaluate and describe the data.
Results: The mean age of the patients in the study was
58±13.71 years. Of the total, 6% of the patients were male,
55.4% stated that they had the CABG surgery between 1 and
4 months prior, and 88.4% went to check-ups regularly after
discharge. The mean HPLP score of the enrolled patients was
110.28±17.32. The patients who were under 55 years of age,
married, had a comfortable income, no comorbid disease,
those who underwent the CABG surgery between 1 and 4
months earlier, went to follow-up regularly after discharge,
and those who were educated about their disease had a high-
er HPLP score (p<0.05).
Conclusion: This study found that patients who underwent
CABG surgery had a moderate HPLP score and that training
on health-promoting behaviors at discharge had a positive ef-
fect on their implementation.
Amaç: Koroner arter baypas greft (KABG) ameliyatı sonra-
sı, hastaların takip etmeleri gereken bir hastalık süreci vardır
ve sağlıklı davranışlar bu süreçte anahtar rol oynamaktadır.
Bu çalışmada, KABG sonrası taburcu olan hastaların sağlığı
geliştirme davranışlarını değerlendirerek etkili faktörlerin be-
lirlenmesi amaçlandı.
Yöntemler: Araştırma Mart-Haziran 2016 tarihleri arasında
poliklinik kontrolüne gelen 152 hasta ile kesitsel olarak yapıl-
dı. Veriler hasta bilgi formu ve Sağlıklı Yaşam Biçimi Davra-
nışları Ölçeği II (SYBDÖ) ile toplandı. Verilerin değerlendiril-
mesine sayı, yüzdelik, standart sapma, ortalama, bağımsız t
ve anova testi kullanıldı.
Bulgular: Araştırma kapsamına alınan hastaların yaş ortala-
ması 58±13 idi. Hastaların %71.6’sı erkekti. %55.4’ü 1–4 ay
önce KABG ameliyatı olduğunu, %88.4’ü taburcu olduktan
sonra düzenli olarak kontrollere geldiğini ifade etmiştir. Koro-
ner arter baypas greft olan hastaların SYBD puan ortalaması
110.28±17.32 olarak bulundu. Elli beş yaş altında ve kadın
hastaların, evli olanların, geliri giderinden yüksek olanların,
ek hastalığı olmayanların, 1–4 ay öncesinde KABG ameliyatı
geçirenlerin, taburcu olduktan sonra düzenli kontrole gelen-
lerin ve taburcu olurken hastalıkla ilgili yeterli düzeyde eğitim
alanların SYBD toplam puanı diğer gruplara kıyasla anlamlı
derecede yüksek bulundu (p<0.05).
Sonuç: Bu çalışmada, KABG ameliyatı geçiren hastaların
SYBD puan ortalamaları orta düzeyde olduğu ve taburcu
olma sırasında verilen eğitimlerin sağlığı geliştirici davranışlar
üzerinde olumlu etkilerinin olduğu bulundu.

Received: April 04, 2017 Accepted: September 21, 2017

Correspondence: Uzm. Hem. Semiha Alkan. Sağlık Bilimleri Üniversitesi Ahi Evren Göğüs Kalp ve Damar Cerrahisi
Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Trabzon, Turkey.
Tel: +90 462 - 231 04 64 / 1186 e-mail: semi.alkan@hotmail.com
© 2018 Turkish Society of Cardiology
170
C oronary artery disease (CAD) is an important
cause of mortality and morbidity due to chronic
disease in the world and in this country.[1] With ad-
vances in medicine and technology, coronary artery
bypass graft surgery (CABG) has come to the fore-
front in the treatment of CAD.[2,3] After CABG
surgery, patients stay in the intensive care unit for the
first 24 hours. Patients are usually discharged within
5 to 7 days after surgery, and re-evaluated at a follow-
up visit within 10 to 12 days.[2,4] After CABG surgery,
patients may experience physical and psychological
problems such as pain, sleep problems, leaks in the
surgical area, limitation of movement, constipation,
fatigue, cognitive problems, and difficult psychoso-
cial adjustment.[5,6]
Health-promotion is not just to prevent disease. Be-
haviors that protect and promote good health include
developing a consciousness of healthy living, improv-
ing lifestyle by avoiding risky behaviors, and feeling
the responsibility to safeguard one’s health for a long,
high-quality life.[3,7] All healthy lifestyle behaviors,
including spiritual development, health responsibility,
exercise, nutrition, interpersonal relations, and stress
management, have an impact on a person’s health and
should be monitored. It is very important to choose
behaviors that are appropriate according to health sta-
tus when organizing daily activities, in order to pre-
vent disease and maintain health.[8] Proper care can
be provided at home with effective hospital discharge
planning that includes meeting individual care needs,
maintaining adequate and balanced nutrition, and ful-
filling daily living activities.[6]
The aim of this study was to determine the de-
mographic and clinical characteristics affecting the
healthcare behaviors of patients discharged after
CABG surgery and to provide guidance on patient
follow-up.
METHODS
Design and sample
The study was conducted cross-sectionally between
March and June of 2016 with 152 patients who came
to the outpatient clinic and underwent CABG. All
patients who came to the outpatient clinic between
March and June of 2016 were interviewed. Patients
who did not agree to participate in the study or who did
not meet the research criteria were not included. Writ-
Turk Kardiyol Dern Ars
ten consent was Abbreviations:
obtained from the CABG Coronary artery bypass graft surgery
Ahi Evren Thorax CAD Coronary artery disease
C a r d i o v a s c u l a r HPLP Health Promoting Lifestyle Profile
Surgery Educa-
tion and Research Hospital administration. All of the
participants were informed in detail of the purpose
of the study and verbal consent was obtained from
those who agreed to enroll. They were guaranteed
anonymity and confidentiality. Participation in the
study was voluntary and patients could withdraw from
the study at any time. Patients were excluded if they
had a mental limitation that precluded responding to
the questionnaires, if they only came for the first and
second postoperative control, or received psycholog-
ical treatment.
Instrument and measurements
The data were collected by the researcher using a
patient information form and the Turkish version of
the Health-Promoting Lifestyle Profile (HPLP). The
HPLP is a 4-point Likert scale consisting of 52 items.
The subscales are spiritual development, interper-
sonal relationships, nutrition, physical activity, health
responsibility, and stress management. For the full
scale, the lowest score is 52 and the highest score is
208 (mean=130).[8,9] The validity and reliability of the
Turkish version of the scale was tested and confirmed
by Bahar et al.[9] in 2008.
Statistical analysis
SPSS for Windows, Version 16.0 (SPSS Inc., Chicago,
IL, USA) software was used to perform the statisti-
cal analysis. Continuous variables were expressed as
mean±SD. Categorical variables were expressed as a
percentage. The Kolmogorov-Smirnov test was used
to test the normal distribution of independent vari-
ables. Variables with normal distribution were com-
pared using an independent samples t-test and a one-
way analysis of variance. All p values less than 0.05
were considered statistically significant.
RESULTS
Of the patients included in the study, 71.6% were
male and 84.2% were married. The average age of the
patients was 58.60±13.55 years. Of the group, 70.4%
had graduated from primary school, 43.8% were re-
tired, and 55.4% had the CABG surgery between 1
and 4 months earlier. The survey responses indicated
Healthy lifestyle in coronary artery surgery
Table 1. Demographic and clinical features of the patients
Characteristics n %
Age
>55 28 15.7
≤55 124 84.3
Gender
Female 59 28.4
Male 93 71.6
Educational status
Illiterate 21 10.4
Primary school 85 70.4
High school and university 46 19.2
Marital status
Single 123 84.2
Married 29 15.8
Job
Housewife 50 32.3
Retired 56 43.8
Officer-worker 17 11.5
Free 20 12.0
Level of income
Higher revenues than expenses 64 42.3
Equal to revenues and expenses 77 50.1
Less revenues than expenses 11 7.6
The story of smoking
Yes 98 73.1
No 54 26.9
CABG: Coronary artery bypass graft surgery.
that 88.4% went for a check-up regularly after their
hospital discharge, and that 61.8% had received ad-
equate education about their condition when dis-
charged (Table 1).
The mean HPLP score of the patients was
110.28±17.32. According to our data, the HPLP score
was significantly higher in patients who were under
55 years of age, female, those who were married, had
more than sufficient income, no comorbidities, those
who had undergone the CABG surgery between 1 and
4 months previously, had regular follow-up visits, and
those who received adequate education about their
disease at the time of discharge (p<0.05) (Table 2).
When the HPLP responses were examined, more
than half of the patients responded with “I do so reg-
171
Characteristics n %
The story of using alcohol
Yes 63 33.1
No 89 66.9
The story of comorbid disease
Yes 128 86.4
No 24 13.6
The story of history of hospital admission
Myocardial infarction 47 36.2
Anjina 36 16.8
Anjio 28 14.7
Referred from another hospital 41 32.3
Operative story outside of CABG
Yes 33 19.8
No 119 80.2
Time to have CABG surgery
1-4 months ago 72 55.4
4-8 months ago 57 30.8
8-12 months ago 23 13.8
Coming to regular control after discharge
Yes 133 88.4
No 19 11.6
Education related to illness
while being discharged
Sufficient 92 61.8
Partly sufficient 33 26.2
Insufficient 27 12.0
ularly” to the statements “I tell a doctor or a health-
care worker about unusual signs and symptoms in my
body,” “I sleep enough,” “I ask questions to under-
stand the recommendations of healthcare personnel,”
“I eat fruit 2 to 4 times every day,” “I consult with the
healthcare staff about how to look after myself better,”
“I get support from people with similar problems,” “I
eat breakfast,” and “I get advice and guidance from
others when I need it.”
DISCUSSION
After CABG surgery, patients must adapt to incorpo-
rating healthy lifestyle behaviors in areas such as nu-
trition habits, exercise, and social and work life. The
172 Turk Kardiyol Dern Ars

Table 2. The mean HLSBS scores of patients according to some variables

Characteristics HPLP Scores p

Mean±SD
Age (years)
>55 114.43±16.10 t=-2.136
≤55 109.33±15.87 p=0.0039
Gender
Female 116.22±19.46 t=-2.567
Male 103.67±17.63 p=0.002
Educational status
Illiterate 108.42±18.21
Primary school 105.78±19.45 F=0.679
High school and university 110.77±18.03 p=0.62
Marital status
Single 105.22±15.34 t=-1.978
Married 101.93±19.49 p=0.044
Level of income
Higher revenues than expenses 112.57±65.23
Equal to revenues and expenses 114.65±18.58 F=3.646
Less revenues than expenses 118.91±17.93 p=0.0033
The story of smoking
Yes 111.87±36.67 t=-1.002
No 113.79±19.44 p=0.072
The story of comorbid disease
Yes 108.58±33.79 t=-2.336
No 112.34±19.65 p=0.003
Time to have coronary artery bypass graft surgery
1–4 months ago 116.36±18.57
4–8 months ago 109.62±12.45 F=4.846
8–12 months ago 101.88±17.62 p=0.001
Coming to regular control after discharge
Yes 119.76±11.43 t=-2.987
No 102.83±11.76 p=0.0023
Education related to illness while being discharged
Sufficient 117.82±18.92
Partly sufficient 115.34±17.77 F=3.459
Insufficient 112.46±16.45 p=0.003
HPLP: Health-Promoting Lifestyle Profile; SD: Standard deviation.

purpose of adopting these behaviors into daily life in
the early period after CABG surgery is to protect and
sustain the life of the patient.
In the present study, the mean HPLP score of the
patients was 110.28±17.32, a moderate score. Simi-
larly, Savaşan et al.[8] reported that the mean HPLP
score of patients with CAD was 128±22. Bayrak[10]
conducted an investigation with participants who had
both diabetes mellitus and CAD, and found a mean
HPLP score of 106.2±17.9. Mohsenipoua et al.[11] de-
Healthy lifestyle in coronary artery surgery
termined that the mean HPLP score in 220 patients
who underwent CABG surgery was 146.79±21.97.
The results of the present study were lower than those
of Mohsenipoua et al.[11] This finding may be a result
of the larger sample used in that study in comparison
with our research. Implementation of healthy lifestyle
behaviors may be related to the adequacy of patients’
discharge training. When there are enough training
nurses and quality care can be provided in clinics, dis-
charge education can influence the outcome.
In the present study, age was found to be a factor af-
fecting patient adoption of healthy lifestyle behaviors.
Those who were 55 years of age or less had a higher
HPLP score than other groups. Similarly, Özarslan[10]
reported that the HPLP scores of patients who were
54 or less were significantly higher. Küçükberber et
al.[12] reported that heart patients in the age group of
49 to 60 years had higher scores on the HPLP scale.
Patients who undergo CABG surgery may experience
difficulty in maintaining daily activities, social activi-
ties, nutrition, and exercise as they age.
In the present study, it was found that the aver-
age HPLP score of the female patients who under-
went CABG surgery was significantly higher than
that of the male patients. In contrast, Altıparmak et
al.[13] reported that female observation of healthy be-
haviors in the 15–49 age group was low. Bayrak,[10]
and Kuru et al.[14] also reported that male patients had
higher HPLP scores. The results of the present study
differed from the literature. It can be said that female
patients should pay more attention to their health in
order to fulfill their responsibilities in the post-opera-
tive process. Social differences may also be a factor.
Studies have demonstrated that married individu-
als were more likely to pursue and maintain health-
promotion behaviors because marriage promotes in-
dividual responsibility and provides social support
and a stable life.[10,12] Similarly in the present study, it
was found that the married patients had significantly
higher HPLP scores than the single patients.
Socioeconomic inequality affects the health of the
whole community in a negative way. Koçoğlu et al.[15]
reported that socioeconomic inequalities were a de-
terminant factor for healthy lifestyle behaviors and
quality of life, and that the individuals who had a high
monthly income had higher HPLP scores. Bilgili et
al.[16] found that individuals who had an inadequate
173
economic status observed fewer healthy behaviors. In
the present study too, it was observed that the average
HPLP score of patients who had a higher income was
significantly higher.
In our research, we found that the mean HPLP
score of patients who had no comorbid diseases was
significantly higher. Küçükberber et al.[12] also re-
ported that patients who had no comorbidities had
higher HPLP scores than the patients with diabetes
mellitus, hypertension, or both. Kuru et al.[14] reported
that as the burden of disease increases, the health-pro-
moting behaviors of individuals may decline.
Patients who have undergone CABG surgery often
experience problems, such as insomnia, nausea, loss
of appetite, and chest pain during the first 3 weeks
after discharge, and these problems may continue for
as much as 6 weeks. As a result, patients may have to
restrict their activities or delay their return to previous
roles.[3] In the present study, patients who had under-
gone CABG surgery 1 to 4 months earlier had higher
HPLP scores. Patients may be paying more attention
to healthy behaviors in order to be able to fulfill their
daily life activities, protect their health, and adapt at
an early stage, despite the physical or psychological
problems they experience after surgery.
In the present study, patients who received ade-
quate information about their illness and what needs
to be done postoperatively when they were dis-
charged from the hospital, and those who went for
regular checkups after being discharged had higher
HPLP scores. Similarly, Özarslan[10] found that pa-
tients who went to follow-up visits and had knowl-
edge of CAD had higher HPLP scores. Safabakhsh et
al.[17] conducted a study with 80 patients who under-
went CABG surgery and reported that the education
provided in the health-promotion program after the
operation recommending positive changes in life-
style reduced the risk factors of CAD and that the
patients became more conscious about healthy be-
haviors. Kurçer et al.[18] observed that training and
counseling for CAD patients increased the level of
physical activity and diabetes compliance.
Limitations
This study was limited to patients who underwent
surgery within the last 1 year and who have followed-
up within 4 months of the start of the study.
174
Conclusion
In the present study, we found that overall, patients
who underwent CABG surgery had a moderate level
HPLP score and that the training given at discharge
had positive a effect on health-promoting behaviors.
This training should take into account the demo-
graphic and clinical characteristics of the patients,
such as age, gender, income level, and additional dis-
ease status. We believe that more frequent follow-up
of those groups at risk in terms of improving their life-
style will increase patient compliance.
Peer-review: Externally peer-reviewed.
Conflict-of-interest: None declared.
Authorship contributions: Concept – S.A., E.T., M.O.H.,
İ.M.; Design – S.A., E.T., M.O.H.; Supervision – M.O.H.,
İ.M.; Materials – S.A., E.T., M.O.H.; Data collection &/
or processing – S.A., E.T.; Analysis and/or interpretation
– S.A., E.T.; Literature search – S.A., E.T.; Writing – S.A.,
E.T., M.O.H., İ.M.
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Keywords: Coronary artery bypass surgery; health behavior; healthy
lifestyle.
Anahtar sözcükler: Koroner arter baypas ameliyatı; sağlıklı yaşam
biçimi; sağlık davranışları.